Hemodynamics, fluids & transfusion
Effects of intravenous paracetamol on mean arterial pressure in critically ill patients: A systematic review and meta-analysis with trial sequential analysis
Pooled result · MAPResult — go to the resultMD −6.75 mmHg 95% CI −10.68 to −2.82Authors' conclusion
Hypotension after intravenous paracetamol is frequent in the ICU, with significant reduction in MAP, SAP, and DAP but no effects on HR. Effects seem more pronounced in patients with fever.
Study context
- Population
- Intensive care unit (ICU) patients receiving IV paracetamol for fever and/or analgesia8 studies
- Comparison
- Mean arterial pressure (MAP) before vs within 30 min after IV paracetamol
- Outcome
- MD in MAP
- Follow-up
- Within 30 min of IV paracetamol
Methodological detailstrial sequential analysis, Grade of evidence very low
- Trial sequential analysis
- Grade of evidence very low
Pooled result
MAP
MD
−6.75 mmHg
95% CI −10.68 to −2.82
P = 0.0008
MAP before vs within 30 min after IV paracetamol
MD −6.75 mmHg (95% CI −10.68 to −2.82); P = 0.0008
As reported in the abstract
Further pooled results
SAP · within 30 min
| MD (mmHg) (CI) | P value | ||
|---|---|---|---|
| After paracetamol5 studies; I2 = 78% · TSA: not robust | −11.55 (−20.55 to −2.55) | P = 0.01 | |
| −30−20−10010Difference, mmHg (linear scale) |
DAP · within 30 min
| MD (mmHg) (CI) | P value | ||
|---|---|---|---|
| After paracetamol5 studies; I2 = 42% · TSA: robust | −5.29 (−8.53 to −2.05) | P = 0.001 | |
| −10−505Difference, mmHg (linear scale) |
HR · within 30 min
- No effects seen for HR
- −3.08 [−7.09;0.93]; p = 0.13; I2 = 0% (4 studies, MD, bpm, 95% CI)
- Trial sequential analysis (TSA): not robust
MAP, paracetamol for fever (subgroup)
- MAP reduction appeared consistent when paracetamol given for fever
- Subgroup analyses hampered by small number of studies
Safety
| Outcome | Values |
|---|---|
| Hypotension | intravenous paracetamol 45.5% |
- Hypotension: n = 143/314, 4 studies
Original publication
Effects of intravenous paracetamol on mean arterial pressure in critically ill patients: A systematic review and meta-analysis with trial sequential analysis. Anaesth Crit Care Pain Med. Published 25 June 2025. doi:10.
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